dinoprostone

Implementation

• Abortifacient: Warm the suppository to room temperature just before use.

» Wear gloves when handling unwrapped suppository to prevent absorption through skin.

» Patient should remain supine for 10 min after insertion of suppository; then she may be ambulatory.

• Vaginal Insert: Place vaginal insert transversely in the posterior vaginal fornix immediately after removing from foil package. Warming of insert and sterile conditions are not required. Use vaginal insert only with a retrieval system. Use minimal amount of water-soluble lubricant during insertion; avoid excess because it may hamper release of dinoprostone from insert. Patient should remain supine for 2 hr after insertion, then may ambulate.

» Vaginal insert delivers dinoprostone 0.3 mg/hr over 12 hr. Remove insert at the onset of active labor, before amniotomy, or after 12 hr.

» Oxytocin should not be used during or less than 30 min after removal of insert.

• Endocervical Gel: Determine degree of effacement before insertion of the endocervical catheter. Do not administer above the level of the internal os. Use a 20-mm endocervical catheter if no effacement is present and a 10-mm catheter if the cervix is 50% effaced.

» Use caution to prevent contact of dinoprostone gel with skin. Wash hands thoroughly with soap and water after administration.

» Bring gel to room temperature just before administration. Do not force warming with external sources (water bath, microwave). Remove peel-off seal from end of syringe; then remove the protective end cap and insert end cap into plunger stopper assembly in barrel of syringe. Aseptically remove catheter from package. Firmly attach catheter hub to syringe tip; click is evidence of attachment. Fill catheter with sterile gel by pushing plunger to expel air from catheter before administration to patient. Gel is stable for 24 mo if refrigerated.

» Patient should be in dorsal position with cervix visualized using a speculum. Introduce gel with catheter into cervical canal using sterile technique. Administer gel by gentle expulsion from syringe and then remove catheter. Do not attempt to administer small amount of gel remaining in syringe. Use syringe for only 1 patient; discard syringe, catheter, and unused package contents after using.

» Patient should remain supine for 15–30 min after administration to minimize leakage from cervical canal.

» Oxytocin may be administered 6–12 hr after desired response from dinoprostone gel. If no cervical/uterine response to initial dose of dinoprostone is obtained, repeat dose may be administered in 6 hr.